Provider Demographics
NPI:1689788507
Name:NOBLETT, BRADLEY DEANE (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DEANE
Last Name:NOBLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 WEST LA VETA AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-835-2724
Mailing Address - Fax:714-835-2751
Practice Address - Street 1:1010 WEST LA VETA AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-835-2724
Practice Address - Fax:714-835-2751
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86364207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G863640Medicaid
CA00G863640Medicaid
G10004Medicare UPIN